NHS could get new access targets in October

Inpatient elective activity should be front-loaded to the first half of 2019-20

Patients waiting over six months will have a mandatory right to switch providers

Half of the existing CQUIN monies will be transferred to national and local prices

Failure to hit new ambulance targets will result in financial sanction

New and revised access targets which result from the review being undertaken by NHS medical director Steve Powis could be applied as early as next October, HSJ understands. The targets will join a range of new performance measure set out in NHS England’s 2019-20 planning guidance.

The prime minister ordered the review of targets in June, saying: “As the NHS develops the priorities and outcomes the long-term plan will deliver, we would like clinicians to confirm the NHS is focused on the right targets – for both physical and mental health – which incentivise the best care and outcomes for patients, and have the broad support of our health professionals.”

Dr Powis is leading the review which covers all the NHS’ major access targets, including the four hour accident and emergency standard and the elective referral to treatment target.

HSJ understands Dr Powis will report in March and that, if the new standards pass a period of trial, it is hoped to implement the new target regime during October 2019 before winter pressures begin.

In its annual planning guidance to the NHS, the national commissioning body has revealed a string of new attempts to manage the provider sector performance.

As part of attempts to reduce extremely long waits for some patients, NHS England revealed plans to bring in new fines for 52-week waits with “mirroring” financial sanctions for providers and commissioners worth £2,500 per breach per organisation. This means the overall value of 52-week breaches will remain at the 2018-19 level of £5,000 – but the burden will be shared between provider and commissioner.

Regional teams will be involved in setting how the funds from fines will be spent for the benefit of the local system.

The guidance said: “Extremely long waiting times for elective treatment lead to poorer quality of care, are frustrating for patients, and present patient safety risks.”

It added the new fines would be subject to the outcome of the standard contract consultation.

Although not included in the guidance, HSJ understands another new measure to be revealed next year will see patients who have waited six months or more for their procedure being proactively reminded of their right to switch to an alternative provider.

The planning guidance said providers will be expected to develop new plans which will include “realistic phasing of non-elective and elective activity across the year”.

It added: “[The plans] should ensure that as much of the annual elective activity – particularly inpatient elective activity – occurs in the first half of the year, before winter. They should also contain effective winter plans, profiling additional winter activity, and the necessary capacity.”

The document also confirmed plans to transfer approximately £500m from national and local commissioning for quality and innovation schemes into national and local prices in addition to a national tariff uplift of 3.8 per cent.

CQUINs are currently worth 2.5 per cent of commissioner contracts with providers with NHSE planning to transfer the equivalent of 1.25 per cent tariff prices in 2019-20.

Areas previously covered by CQUINs which are now proposed to be included in the NHS standard contract include improving sepsis care and antimicrobial resistance.

The planning guidance also stated: ”New national standards for ambulance response times took effect from 1 April 2018. Now that these have bedded in, we propose to introduce financial sanctions for failure to achieve certain of these standards.”

Although NHS England has published its outline strategy for the planning guidance, the technical details and key deliverables will not be published until January.

National bodies and government need to to support NHS leaders and staff to make changes to local relationships, to bring about integration in the interest of their communities, and create the right legislative and regulatory framework for local leaders and their organisations to succeed. By Niall Dickson